Many arthritis sufferers struggle with knee pain at night – that dull, persistent aching seems to be a feature of osteoarthritis.
Why at night? Scientists aren’t completely sure. Perhaps it’s partly because our joints stiffen up when they remain stationary. But it’s probably also related to inflammation. Levels of the anti-inflammatory hormone cortisol naturally drop at night, while inflammatory mediators (chemicals that create an inflammatory response in cells) build up during the day. So it may be a combination of factors.
One thing is certain, though – night-time knee pain plays havoc with sleep. So what can you do to improve the situation? Here are some ideas that may help.
Stay active during the day
When you have painful knees, it’s tempting to stay off them as much as possible. The trouble with inactivity, though, is that it leaves you feeling less ready for sleep – less tired out – at day’s end. So the key is to find a balance that works for you – between resting your knees and staying active enough throughout the day to feel worn out (in the right way) by bedtime.
Find your best kind of active
Of course, all activities aren’t made equally. You may want to rethink sports or pastimes that are actually making your knee pain worse – long runs, perhaps, or hours of weeding in the garden, or other weight-bearing activities. Consider switching to a hobby that keeps you well-exercised without overburdening your knees: swimming, light walks and cycling are good potential alternatives.
Refocus your routines
Studies show that pain is made worse by poor sleep, so it’s not hard to get into a vicious cycle. Most of us know the basics of good sleep hygiene – avoid caffeine in the afternoons; cut down the alcohol; turn off electronic devices at least an hour before bed; get up and turn in at the same times each day, and so on – but it’s easy to tumble back into bad habits. Time for a sleep-routine rethink? The NHS has some useful pointers here.
Tweak your pain-relief timings
Taking prescription pain relief, or an over-the-counter pill like paracetamol, obviously eases night-time pain – but when you take it is important. Does your pain typically start as soon as you lie down? Or (more typically) is it worst after three or four hours? It’s worth thinking about how to coincide that ‘peak-pain time’ with the point of optimum relief from the medicine – how long your particular medication takes to kick in, how long it lasts for, and so on. A doctor can advise you on this.
Support yourself in bed
Small adjustments can make a difference to knee pain in bed. Some people find that a softer mattress, or even a lighter duvet, is a big improvement. Some support between the legs, like a cushion, may be helpful too. We usually advise against sleeping with a pillow behind the knee, because it can raise the risk of a ‘fixed flexion deformity’, where a contracture at the back of an arthritic knee can ultimately lead to straightening problems in the leg. We also don’t recommend using restrictive knee supports in bed, due to the risk of circulatory problems such as DVT.
Try bathing before bed
Warm baths are an old trick for lulling the mind towards sleep – it’s actually the fall in body temperature when you get out that triggers this. One study found that 1-2 hours before bed was the ideal time for a bath, from a sleep quality point of view. But warm water can be helpful for knee pain too: it improves circulation, reduces swelling and provides some pressure-relieving support for the legs.
For further reading
More about osteoarthritis and how it affects the knees
Sleep tips if you’re planning to have knee surgery
How applying heat and ice can help to manage joint pain
Is arthritis stopping you from getting a good night’s rest? We’ll be happy to help you tailor a plan to manage your knee pain and improve your comfort during sleep. Drop us a line and we’ll book you in for an appointment to explore the options.